Abstract

Exclusive breastfeeding (EBF) has been practiced all over the world as the best cost effective way of feeding infants. In Cameroon, breastfeeding is a norm and essential for child survival. However, the pandemic HIV/AIDS and the recognition that HIV positive mothers can transmit the virus to their babies through breast milk precipitated a terrible public health dilemma in countries like Cameroon where incidences of HIV is high. The main objective of the study is to determine factors influencing the choice of infant feeding options among HIV positive mothers in Mbengwi District Hospital North-West Region, Cameroon. Specifically, the study seeks to determine maternal knowledge on mother-to-child transmission of HIV, to identify current infant feeding practices in HIV positive mothers and to establish factors that influence the infant feeding choices for HIV positive mothers in Mbengwi District Hospital. In order to achieved the study objectives, a cross sectional survey design was chosen to sample 40 HIV/AIDS positive mothers using a structured questionnaire through a random and convenient sampling techniques. The study findings revealed that mothers in Mbengwi District Hospital have high knowledge MTCT of HIV. However, there was general poor adherence to WHO (2010) guidelines. The choice of maternal-infant feeding practices was to a greater degree influenced by social and economic factors within the mothers living environment. These factors included mother’s education, occupation, parity and HIV status of infant. The study also concluded that, mixed feeding was the most infant feeding practice during the first six months of life. The infants are breastfed and at the same time introduced to foods such as mashed food, formula feed and warm water. Poor adherence by mothers to recommendations provided by the World Health Organization (2010) was noted. In conclusion, the null hypothesis stating that the choice of infant feeding practices among HIV positive postpartum mothers is not associated with the level of maternal knowledge on MTCT of HIV and socio-economic factors is rejected. The study recommended that more efforts should be made by the government to enable women to have more maternal leaves and for creating income-generating opportunities so that mothers could decide and adhere to EBF at least for the first six months and continue breastfeeding with an appropriate complementary feed until 12 months.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

HIV/AIDS is possibly the biggest challenge facing the global health care system today. One of the global strategies for controlling, and preventing the spread of HIV/AIDS is the prevention of mother – to – child transmission of HIV/AIDS (PMTCT) program. PMTCT aims at preventing HIV infection of the infant during pregnancy, labor and breastfeeding and has been very successful since its inception. It remains the best way of preventing paediatric HIV infection (Mukhtar-Yola et al., 2009). Breast feeding has also been associated with a high level of paediatric infection. The transmission associated with it (breastfeeding) is high during primary maternal HIV infection as mirrowed by a high but transient peak in breast milk HIV load (Nduati et al., 2000 and Datta et al., 1994). Exclusive breastfeeding however has been associated with reduced postnatal transmission of HIV from mother to child more than mixed breastfeeding. Also formula feeding has been associated with higher risk of infant mortality than breastfeeding (Kagaayi et al., 2008). These imply that despite the risk of HIV infection, breast milk is still too important for the survival of the HIV – exposed infant.

Mother to child transmission (MTCT) is the main route of transmission in children under 10 years and more than 5.1 million children become infected with HIV yearly with the majority in Africa. Infection routes of HIV from an HIV-positive mother to her child are during pregnancy, labour, and delivery or through breastfeeding.

Prevention of mother-to-child transmission (PMTCT) of HIV is an important intervention in the prevention and control of HIV and AIDS to reduce child mortality and increase the rate of child survival. Mother-to-child transmission (MTCT) of HIV interventions requires more than the provision of drugs and commodities. Systems must be strengthened and communities need to be prepared for this program. Therefore, the commitment to providing a range of core MTCT interventions is required to reduce the incidence of MTCT of HIV.

The successful implementation of two interventions using antiretroviral drugs, nevirapine and azidothymidine used concomitantly has proven effective to avoid MTCT during pregnancy and at birth (UNAIDS, 1999). The two drugs simultaneously used with effective infant feeding adjustments can reduce MTCT of HIV considerably.

Breastfeeding is regarded as the best way to feed infants, as breast milk is a rich source of nutrients for infants. Breast milk is also highly recommended for infant feeding because it contains agents, which increase resistance against disease ensuring good health. This would be an aspect which influences mothers to breast-feed their infants. This does not necessarily apply to HIV positive mothers who are faced with the challenge to choose the best feeding practice for their infants to best suit their situation.   infants. This does not necessarily apply to HIV positive mothers who are faced with the challenge to choose the best feeding practice for their infants to best suit their situation.

Decision making on infant feeding is a very vital aspect of child care but continue to pose a challenge to HIV positive mothers. Very often women breastfeed their infants to avoid the stigma associated with not breastfeeding, high cost of alternative feeding methods, or lack of access to safe water (Igbokwe et al., 2016).

These factors have provoked critical considerations for policy and programs targeted towards mitigation of adverse effects caused by HIV in women and children. Governments and non-governmental organizations are rolling-out Anti-Retroviral treatment (ART) to improve the health and well-being of infected women, through programs that couple prevention of mother-to-child transmission with continuing treatment to help mothers remain alive and in good health to care for their children.

1.2 Statement of the Problem

It is estimated that about 1000 children get infected with HIV daily through vertical transmission. According to UNAIDS (2008), breast milk contributes 15%.  The risk increases (25-45%) with the age of the infant and maternal practice of mixed infant feeding before 6 months (KNBS, 2009), Supporting optimal infant feeding practices was a challenge for health systems (WHO, 2010).

HIV positive mothers have to decide on the best feeding practice for their infants. The choice ultimately lies with them although there are various external factors, which may influence the ultimate decision on whether to breastfeed or use replacement feeding. The two safe recommended infant feeding practices for HIV positive mothers are exclusive breastfeeding or exclusive replacement feeding.

Prevention of Mother to Child Transmission of HIV/AIDS in Sub-Saharan Africa has already suffered a defeat owing to the gap between global politics and local realities (Maman, 2001). Over the last four decades, the knowledge of HIV/AIDS has increased and so have the number of people affected (Sweeney, 2005). In 2010, reports from the National AIDS Control Committee (NACC) of Cameroon showed that about 7,300 babies were born HIV positive due to MTCT (Ministry of Public Health, National AIDS Control Committee, 2010). Worldwide 2.5-3.5 million children die AIDS-related deaths; this causes shortfalls in the achievements of the 4th and 5th-millennium development goals (Newell, 2006). The prevalence of pediatric HIV continues to be on the rise despite so much national and international efforts. For these reasons, the investigators felt the need to assess the challenges faced by nurses and midwives in eliminating MTCT of HIV/AIDS.

In communities with fewer resources, where replacement feeding can be much more dangerous, the recommendations for infant feeding usually depend on a mother’s situation. Although there is some variation in national and local policies, most are influenced by the guidance published by the World Health Organisation (WHO). According to the latest version of this guidance, “When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life” (WHO, 2007). This means that some mothers should be counselled to breastfeed and others should be encouraged to give replacement foods as an alternative, depending on personal circumstances. The final decision, however, should be taken by the mother who determines the appropriate infant feeding practice for her circumstances.

This apparent ability or inability of HIV-positive mothers to adopt the recommended infant feeding options have been linked to several factors which impinge on their decision-making processes and perceptions and these factors includes a strong socio-cultural value in favour of breastfeeding linked to historical traditions and contemporary state and international development discourses (Van Hollen, 2011). Thus beyond the clinical and epidemiological debate and given the socio-cultural importance attributed to breastfeeding and the prevailing poverty in most developing countries like Cameroon where Mbengwi is found, it may be more important and necessary to promote exclusive breastfeeding followed by other methods.

Although these guidelines acknowledge the various circumstances which HIV positive women face, they do not communicate the complexities of women in low resource communities in making such decisions. Although HIV positive mothers want to keep their children HIV free, they also face various challenges which contribute to their infant feeding choices. The knowledge gap which exists and poses challenges to adapting policies on infant feeding is what factors influence infant feeding practices for HIV positive mothers in a low resource community like Mbengwi?

1.3 Objectives of the Study

1.3.1 Main Objective

The main objective of the study is to determine factors influencing the choice of infant feeding options among HIV positive mothers in Mbengwi District Hospital North-West Region, Cameroon.

1.3.2 Specific Objectives

1. To determine maternal knowledge on mother-to-child transmission of HIV in Mbengwi District Hospital
2. To identify current infant feeding practices in HIV positive mothers in Mbengwi District Hospital
3. To establish factors that influence the infant feeding choices for HIV positive mothers in Mbengwi District Hospital.